王肯堂对丹溪学派相火学说的继承和发挥

Inheritance and innovation of the ministerial fire theory in the Danxi school by WANG Kentang

明末医家王肯堂系统地继承了丹溪学派的相火学说,并运用这一学说恰当地阐释了一些疑难病证的发病机制。目前中医教材的理论不易解释阴虚何以发生水肿,王肯堂则从肾经受邪,相火郁遏,郁极而发,引动水气的角度提出一种独特的解释。一般认为癫痫是体内固有的痰涎闭阻脏腑气机而成,而王肯堂提出一种新的机制,水不涵木,肝风内动,引动痰涎,即部分痰涎是继发于肝风。治疗方面,王肯堂认同丹溪学派以滋阴降火对治相火妄动,但对具体用药则有所辨正。例如,他反对以知柏四物汤治疗阴虚痨瘵,因为久服知母、黄柏将伤阴助火,并使人体气机降而不升,而川芎、当归性温上行,将助长阴虚火炎之势。此外,他对八味丸中肉桂、附子功效的独到见解,也具有较高的参考意义,但他对大补阴丸中龟甲的认识,则是错误的。

WANG Kentang,a medical scholar during the late Ming dynasty,systematically inherited the Ministerial Fire Theory in the Danxi School and explained the mechanism of some complex diseases using it.The current theory of traditional Chinese medicine teaching materials has difficulty explaining why Yin deficiency can cause edema.However,WANG Kentang successfully proposed a unique explanation from the perspective that the kidney meridian is affected by evil Qi,and ministerial fire explodes and induces water.Generally,the public believes that epilepsy is caused by inherent phlegm closing and blocking the Qi of organs in the body,while WANG Kentang proposed a new mechanism.A weak kidney cannot nourish the liver,and the Qi in the liver rises and induces phlegm,that is,some of the phlegm is attributed to Qi in the liver.In terms of treatment,WANG Kentang identified the method of nourishing yin to relieve fire for treating hyperactivity of the ministerial fire,and he corrected this with the administration of some herbs.For instance,he opposed the treatment of Laozhai(severe cases)due to Yin deficiency with the Zhibo Siwu decoction because taking in Zhimu and Huangbo for a long time would hurt Yin and help fire,and thus reduce the Qi of the body without rising.However,the heat of Chuanxiong and Angelica sinensis would increase the trend of Yin deficiency and the disorder of the ministerial fire.In addition,though his original views on the efficacy of cinnamon and monkshood in the Bawei pill also have high reference significance,his understanding of the tortoiseshell in the Dabuyin pill is wrong.